Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

We have a Cochrane systematic
review aggregating data from 12 trials showing that continuous
electronic fetal monitoring (EFM) increases the c/sec rate and
decreases the neonatal seizure rate. But if you look at the
individual trials, you find that one of them, the
second largest, was carried out at the Dublin National
Maternity Hospital, the hospital that is Ground Zero for active
management of labor, a protocol that treats any woman not
progressing at the average rate with high-dose oxytocin. That is
the trial you cite. In that trial, not surprisingly, excess
neonatal seizures occurred in the group with the longer labors who
received oxytocin, and continuous EFM was protective. The neonatal
seizure rate overall in this population was
10 times that of the biggest study (3 per 1000 vs.
3 per 10,000), which took place in a U.S. hospital. Because of
the size of the Dublin trial, and the high seizure rate compared
with other trials, if it were excluded,
the difference between rates between EFM and intermittent
auscultation would almost certainly become clinically
insignificant if not statistically insignificant (i.e., likely to
be due to chance). On the other hand, it appears that if
you're going to expose women to high-dose oxytocin,
continuous EFM could help protect the fetus from the adverse
consequences of doing that. Since women are not in a position
to dictate what oxytocin protocol their ob uses, my recommendation
was to use EFM when being induced. Of course, the better
solution would be to reserve induction and augmentation for when
they are truly needed and to use oxytocin regimens based on the
research evidence of how oxytocin is metabolized, but I don't see
that happening any time in the near future.

-- Henci

All Times America/New_York

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